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"Never doubt that a small group thoughtfil, committed people ca change the world. Indeed, it is th only thing that ever has. -Margaret Mead

State Council Conference - p.2 a



CONSUMER PROTECTION NEEDE New Legislation Proposed Patient Protection Act by Charlie Smith, Editor



.. -

The bill establishesbasic consumer protections for all Minnesotansregardlessofthe health care company in which they participate. Provisions include:


Health Care Consumer Assistance Program and Over-



any incentives that affect the availability of services or referrals. Health careproviders who are licensed, credentialed or registered by a licensing board must be correctly identified.

I . has a life threatening physical condition, or mental illness, or a chronic health ' care condition; or 2. has adegenerative disease, physical disability,mental retardation or otherrelatedconditions; or




Establishes a one-stop shop and advocacy program for consumer information on the health care system, one's rights as a health plan enrollAlan Reick presen air of ;MinneapolGAdvisov ee, any app~alsavailable to on People with Disabilities, Joan Willshire,for the Committee's winning of a nationalfirst them, triage to the appropriprize for Commuttity Involtlement. (Pictured lefl to right) Mike Opal, Hennepin County ate ombudsmen offices and Commissioner; Sharon Sayles Belton, Mayor of Minneapolis; Alan Reich, President of the advocacy during the appeal National Organization on Disability; Uri C m e ~ aPublic , Relations Manager of Ut~ited process for consumers that do . .-.. . by Dawn Doering not traditionally have an adParcel Service; and Joan H'illslrire. vocate available to them.

Foreclosure: Woman May Lose Her Home

by Jeff Nygaard took out a $10,000 loan from TCFtoreplace her oil furnace and to pay off credit carddebt. As the story will show, this was a dificblt debt to handle for awoman withUdirninished intellectual capacity and . . . certain learning disabilities" which "restrict her ability to know and understand" the In 1987, after Kathy's father meaning of a loan like this (as died, the family house was put her current lawsuit against into Kathy's name so that she TCF states). would always have a home. Now, after approving an im- Aftermaking acouple of small payments on this loan, Kathy possibly large loan to Kathy with payments so burdensome began to use her credit card to that Kathy was never able to try to pay it off. The credit make a single one - Twin Cit- card debt grew, and nine ies Federal (TCF) Bank is try- months later she applied to ing to foreclose her mortgage Associated Bank in So. St. and leave her with nowhere to Paul for a loan of $18,358 to live. Would TCF do this to a pay off the TCF loan. person with no disability? Kathy was in overher head, as Let's look at the fact.. anyone with banking (or bor[n October of 1994, Kathy rowing) experience could see.

Kathy, a middle-aged Twin Cities woman with a mild developmental disability, may lose the home she's lived in for40 years. Her story, which is by no means over, contains some lessons for all people with disabilities and their friends.


Predictably, she soon got behind again. After a few months, she went back to TCF and asked for another loan. Remarkably, TCF approved her request and loaned her $4 1,000. Atthis point, Kathy's "friend" AM came to live with her. Soon Ann began to take advantage of Kathy's trusting nature. Kathy loaned her friend thousands of dollars, based on false promises of repayment. After AM moved out last May, Kathy's family found never-before-seenbills stuffed into drawers, andmore would soon anive - forjewelry, furniture, cellular phones, andthousandsof dollarsworth of calls.


Establishes a board of consumer representatives to design and oversee the advocacy program and to monitor trends in patient complaints and resolutions to those complaints. Consumer Complaint Process: Establishes a quicker, faster timeframe for internal health care company appeals processes; including 48 hour turn around for medically urgent complaints, 15 business days for referrals, and 30 days for all other complaints. Establishes an independent appeals process for consurners to directly access either mediation or arbitration. Disclosure of Health Care Provider Information to Consumers:

Health plan companies and providers must discloseto the public the provider payment Foreclosure - cont. on b.5 I plans that they use including

A little bit about Kathy: She has had a steadyjob for about

sumers with acopy ofan itemized and intelligiblebill whenever the consumer must pay for any portion of the bill. Health care providers, upon request, must provide a sumofany surveys or results surveys in which it participated,


d.33-- -



E n d

trimester of pregnancy at the effective date of enrollment, in which case the enrollee shall be allowed to receive health services throu care directly ., delivery. ~

~of care:~

A new health plan company Health plan companies must enrollee, whose current health disclose to consumers a sum- care provider is not part ofthe mary of any incentive plan enrollee's new health plan that transfers "substantial fi- network, will be allowed to nancial risk" to a health care .finish a course of treatment with hisher current provider provider. if the enrollee: Access to Emergency Care: 1. has a life threatening physRequires a health plan com- ical condition, or mental illpany to establish a toll-free ness, or a chronic health care number for enrollee's to call condition; or for information about emer2. has a degenerative disease, gency services. physical disability, mental reDefines emergency service as tardation or otherrelated conwhat an average person would ditions; or consider as an "emergency". 3. has entered the second Procedure for Specialty trimester of pregnancy at the effective date of enrollnlent, Referrals: in whichcasetheenrolleeshall be allowed to receive health Health plan companies must services through postpartum have a procedure by which an care directly related to the enrollee who needs ongoing delivery. care from a specialist may receive a standing referral. 4. does not speak English or Health plan companies must is receiving culturally approhave a procedure for a referral priate services (this language to a specialist who will be mirrors protections provided responsible for coordinating to recipients of PMAP). the enrollee's primary and specialty care if the enrollee: An enrollee,whose health care

Protection - cont. on p.3



March 1997  

March 1997 issue

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